We have two sets of volunteers that we’re going to have sign ups for. For the timelines, first are the steps for dissemination of GMP-USA version 1.0. We’re going to ask for volunteers for some of this.

In July 2008 we will complete and approve the cover letter here at Summit VI. Agree on authors and "approvers" for side-bar comments. Final version of GMP approved within 2-3 weeks of Summit VI.

In August 2008 we will publish version 1.0 with cover letter and with database comment facilities on the GMP-USA web site so it is captured in a structured manner.

In September 2008 we will notify Alliance participants that they can now take charge of further distribution of information about the GMP-USA web site These groups are the ones we talked about:

In October 2008 we'll add the "bullet" survey to the web site, open it to public comments (with the results to be segregated from controlled investigational sample). Since there is limited availability, there is no reason not to collect the extra data as that is informative to our further discussions.

In January 2009 we will close first round of comments. We would include in the cover letter information that this will happen. Staff will collate feedback for review by mid-January. We need a panel of Alliance volunteers to review feedback and suggest Summit VII activities relating to the feedback (and maybe version 1.1 or 2.0).

In February 2009 a group from the Summit reviews feedback and decides on changes based on feedback and next steps.

Secondly, we have a timeline with steps related to the bullet survey (research format):

In July 2008 we will revise survey instrument based on input from Summit VI and discuss distribution with appropriate sponsors for participants to give us feedback. These could be:

Consumers Union for public

AMA and AOA to seek input from practicing delegates

AAMC and AMA to collaborate on creating a sample of practicing doctors to receive the survey

In September 2008 we will finalize plans for inviting individuals to participate.

In October through December 2008 we will do data collection of the feedback.

In January 2009 we will have the data analysis with the primary goal to identify those bullets needing work at Summit VII.

There are some assumptions about staff availability and volunteers. We recommend two volunteer groups: one to review and develop the sidebar comments and the other to review and analyze the feedback.

Ideally there will be a group who will pre-process some of these comments to save us some work at the next summit.

Some of the issues that came up in the previous discussion centered around the idea of inviting and what to do about other stakeholders, how we’re going to address individuals, and how to address funding.

We made a big change by adding individuals and accountability. We are now silent about eligibility. Maybe they will go through the steering committee? We want to maintain the inclusivity that we’ve had so far. We’ll rely on peer pressure from the group to maintain a civil conversation and a civil commons. We eliminated the part that said, if you don’t behave you’re out.

We hope that it’s welcoming to other stakeholders. It will go out with a cover letter that will say more about the Alliance. We have addressed individuals. Some of the points are only applicable to organizations and we reflected them separately.

We think the financial language is good enough for now.

Our next steps if you agree this is good enough, this will go out with a cover letter with a second page with a place to sign. We will defer the language of the cover letter to the steering committee. The assumption has been that it will go to all the organizations that have been participating. But we haven’t talked about whether we’re going to go out and seek other participants.

Q: Is the intent organizational? I think we want to convey that.
A: The document was precisely that this morning and we got feedback that it should also include individuals. So it feels a bit like ping-ponging.
Response: I think it’s actually okay the way it is.

Summary of any recommendations coming from the Steering Committee (if necessary)

Summary of the use of the trusted agent within the Common License Application Form (CLAF)

Examples of data from initiatives such CAP, IPPI, the Minnesota data project, etc.

Copy of the final participation agreement

We hope to have these outcomes:

Integrate the feedback received on GMP 1.0 and update as necessary.

Finalize participant agreement and establish deadline for organizations to approve their participation

Continue work on trusted agent, based on application of pre-summit reading on status of trusted agent/CLAF, "Data" groups, and IPPI Report.

Application of pre-summit reading assignments on the VA

Small group work on any additional activities identified in today's report out (if applicable).

React to recommendations of the steering committee.

Work group to outline potential publications.

We want to continue to extend an invitation to all individuals and organizations that have attended any of the summits, consider adding other medical organizations that are not yet participants in the Alliance, and consider extending an invitation to CMS

Our time frame is that the next summit would be in mid-January or February to allow sufficient time to obtain feedback on GMP 1.0. We also suggest setting the GMP response deadline for mid-November.

Comment: I think we’ll want to identify some outcomes that we’ll want to achieve.

I think the summits are wonderful but I’m not that young, I don’t have that many more years left, I think every 6 months is not urgency and I’d like to see that work is happening more frequently and between summits.

We explored several categories of things that are happening out there. We look at the educational continuum (UME, GME, CME). We
need to index and catalogue resources with a focus which is less on the system (QI) and more on performance improvement. We also want to consider those initiatives that are top down vs. bottom up vs. a mixed (or hybrid) model.

Our next steps are to survey what's out there, to categorize results by shifts and other dimensions, to mount on an informational web site, to learn from the projects, to develop criteria for success, and to share results more widely.

Although physicians strive to demonstrate the desirable characteristics of a good doctor as outlined in A Guide to Good Medical Practice, the current environment prevents full realization in many settings. We believe that physicians must take a critical leadership role in addressing the current systems barriers to good medical practice. Success is dependent on strong collaboration with other key stakeholders. Opportunities for change that would support physicians' ability to realize the tenets set forth in the Guide to Good Medical Practice to include, but not be limited to... and this is where we want you to go into the wiki and make your suggestions.

This group was tasked to discuss ways the Alliance could promote the shift from the old to the new for the 14 items identified by a previous group's work.

Perhaps we do have leaders in some of these areas. We should probably choose which areas that the alliance should or could be involved in moving things along.

We also want to point out what was novel and not already done. We thought that we should have this group appoint an author to a piece that can be developed for publication. We also need talking points we can use with our organizations.

We need to be able to explain what this new state is all about.

We discussed prioritizing the items and focusing on those that the Alliance might be best suited to promote. We recognized that promotion and endorsement of the 14 items by the Alliance might have a secondary benefit of 'putting the Alliance on the map’. We discussed the role of the Alliance in assisting each participant's Board/organization's acceptance of the 14 items. We discussed the role of the alliance participants' boards and organizations promotion of the individual items. We discussed educational tools to 'spread the word', such as speakers kits and information packets. We reviewed the relationship between the GMP and the shift items. We talked about levers the alliance might be able to employ to promote the shift items.

It appears clear that further discussion regarding the development of strategies to promote the Alliance's endorsement and promotion of the shift items needed to occur.

The publication also represents the messaging. It has a convening power that can be emulated in my own organization. It stimulates collaboration. If our goal is to bring a culture of improvement, then what are the strategies and goals that this group represents? We’re not replicating what other organizations are doing, but highlighting what is unique in this shift.

MK: It’s really an honor and we appreciate being invited to participate with you.

At the first summit we talked about bringing together groups that have tension between them and I appreciate the way we’ve been able to navigate through this.

I appreciate the way you put up the information for us. It was really helpful.

MK: Thanks to Chad for inventing this Illumination Gallery, which is what we call this structure behind us. This is the first time we’ve used this video wall and I think it really brought another dimension to displaying the information.